The present invention relates, in general, to a surgical retractor and, in particular, to a new and useful illuminated retractor for creating a working space for dissecting instruments in support of a surgical procedure such as a procedure for performing surgery in the pelvic area of a patient or other types of procedures which require the retraction of tissue at a relatively deep location in the body of a patient.
The present application is with U.S. Ser. No. 09/071,786 filed on May 1, 1998 now U.S. Pat. No. 6,228,025 and both applications are commonly assigned to the assignee of the present application.
In certain surgical procedures, such as abdominal or gynecological reconstruction or resection procedures, it is necessary to retract tissue at a relatively deep location in the body of a patient. In these surgical procedures, it is also necessary to remove or retract a portion of tissue or an organ in a patient during the procedure. Various specialized retractors are available and although they provide the physician with access to the desired tissue, a separate source of illumination is often required. Common examples of these deep pelvic types of surgical procedures include, pelvic floor reconstruction, vaginal vault reconstruction, prostatectomy, anal resection, abdominal perianal resection and low anterior resection procedures.
In a deep pelvic procedure, it is important to provide reliable access to the desired tissue by retracting the tissue around the surgical site. Once this tissue is retracted, it is important to retain the tissue or organ out of the surgical site during the entire procedure. Therefore, a St. Mark""s style retractor is currently available to provide access to the desired tissue. A St. Mark""s style retractor consists generally of an elongate flat member with a perpendicularly extending bottom surface and a perpendicularly extending top surface and a handle that is attached to the perpendicularly extending top surface. Currently, the physician must use a separate light source such as a head-mounted light or a separate lighted instrument to illuminate the head-mounted light is used and the surgical site is located deep within the body of the patient, it is often difficult to view the desired tissue without shadows from the adjacent tissue. Because the available tissue opening is relatively limited, it is desirable that the number and size of instruments be kept to a minimum. It is also desirable to provide a source of light inside the retracted tissue area to illuminate the tissue of interest without obstructing the view of the surgeon.
The present invention overcomes the drawbacks of limited movement and limited workspace created by the use of the presently available surgical instrumentation and the limited and distorted visual perspective provided by the use of a separate source of illumination. It is therefore desirable to provide a means of providing illumination to the surgical space formed by the retractor so that the physician and physician""s assistant can efficiently view and operate in the entire surgical field exposed by the retractor.
The present invention overcomes the disadvantages of the prior art. As shown in the drawings, the present invention provides an illuminated retractor for illuminating the surgical field from a location along the side of the surgical field.
The illuminated retractor provides a large, well illuminated surgical field, which preferably extends the substantial length of the retractor within the surgical space created by the retractor and further includes a shielded area to prevent the illumination from shining into the eyes of the physician or physician""s assistant.
The illuminated surgical retractor preferably has a handle member, a first elongate section and a second elongate section. The handle member is preferably contoured to be gripped by the operating physician""s assistant and is connected to the first elongate section at the distal end portion of the first elongate section, thus permitting one-handed use by the physician""s assistant. The handle member permits the retractor to be lifted at any desired angle with respect to the surgical field. Thereafter a pulling force may be applied to the handle member so that a corresponding pulling or retraction force is applied to the tissue via the first elongate section. This force creates the space along the surgical field when the desired tissue or organ is drawn away from the tissue surrounding the target area. The handle member may also have an elongated rod extending from the opposite end portion of the handle member that allows the retractor to be maneuvered into the desired position by the physician""s assistant and then fixed in the desired relative position by clamping or grasping the retractor with the available operating table retention mechanisms. As used herein, reference to the proximal end portion of an element is the end portion of an element that is spaced apart from the handle member and reference to the distal end portion of an element is the end portion of an element that is generally adjacent to or closer to the handle member of the preferred form of the present invention.
The first elongate section preferably has a first elongate proximal end portion, a first elongate distal end portion, a first elongate outer surface, and a first elongate inner surface. The first elongate section preferably functions to transfer to lifting and/or retention forces from the handle member to the tissue or organ of the patient. Similarly, the second elongate section, which may be substantially transparent, has a second elongate proximal end portion, a second elongate distal end portion, a second elongate outer surface and a second elongate inner surface.
The first elongate proximal end portion preferably has a generally blunt shape having a small lip member thereon that allows the retractor to be pushed into the surgical site and retain the desired tissue or organ. Additionally, the first elongate proximal end portion preferably includes a pair of tab members or similar retaining members thereon to retain the proximal end portion of the second elongate section therein. In the preferred form of the tab members, the proximal end portion of the second elongate section is insertable laterally into the tab members on the proximal end portion of the first elongate section. The tab members preferably extend outwardly a small distance beyond the face of the proximal end portion of the first elongate section. The face of the upper and proximal surfaces of the first elongate section is preferably slightly curved to provide a low profile that assists in the retention of the tissue while the lower and distally extending portion protects and retains the proximal end portion of the second elongate section therein. The sides of the first elongate section are also preferably slightly tapered so that the width of the first elongate section is less than the width of the first elongate section adjacent to the upper portion thereof.
The second elongate section preferably functions to perform the illumination feature of the present invention. The second elongate outer surface of the second elongate section is preferably slidable laterally with respect to a portion of the first elongate section and into engagement with the first elongate section such that the first and second elongate sections are substantially adjacent to each other and are generally aligned with each other. The retractor further includes a shield member along the distal end portion of the second elongate section to shield the user from the illumination from the second elongate section adjacent to the handle member.
The proximal end portion of the second elongate section preferably has a rounded shape or, alternatively, a smoothly radiused pointed shape. The shape of the second elongate section proximal end portion is preferably complementary to the shape of the recess between the tab members of the first elongate section proximal end portion so that the proximal end portion of the retractor, when the first and second elongate sections are connected, can readily retain and illuminate the tissue or organ along the surgical site as the retractor is inserted into the surgical site or field and maneuvered into position and so that the proximal end portion of the second elongate section is securely retained in the tab members with a relatively low side profile. Additionally, the proximal end portion of the second elongate section is also preferably configured to direct light forwardly of the retractor during use.
In order to enhance the reflective qualities of the illuminated retractor, the first elongate inner surface of the first elongate section may preferably include a mirrored surface thereon. Also, the second elongate inner surface of the second elongate section may preferably have a surface thereon that refracts the light forwardly at a desired angle. The mirrored surface of the first elongate inner surface and the surface of the second elongate inner surface function to minimize the light intensity loss of the light energy that is provided to the surgical field by the illuminated retractor. Alternately, the second elongate inner surface may be reflective to direct to the illumination outwardly from the second elongate outer surface. Furthermore, the second elongate section may be constructed so as to reflect to the illumination forwardly from the second elongate section to illuminate the tissue in the surgical site generally along the length of the illuminated surgical retractor. For example, the second elongate section may be formed so that the light is transmitted at a forward angle that is between about 15 and 75 degrees and more preferably between about 30 and 60 degrees relative to the second elongate section while also scattering the illumination to the sides along the first elongate section of the retractor as desired. Furthermore, although the preferred form of the second elongate section is a clear plastic or similar member, it is anticipated that various elements may be used such as light pipes, fiber optic panels or other available components that function to illuminate substantially the entire length of the retractor.
The preferred form of the retractor may also include a light shield along the upper portion of the first elongate section to shield the user from the illumination from the upper portion of the second elongate section and a connector between the handle member and the first and second elongate sections. This connector is preferably a twist type of connection between the second elongate section and the light cable. This connection is preferably simple to make, such as by a one-quarter turn, and is secure to ensure that the second elongate section remains attached to the first elongate section and the handle member as the retractor is inserted and the tissue or organ is retained by the physician""s assistant. The connector also connects the light cable to the second elongate section to ensure that the light energy travels from the light source, through the connector and into the second elongate section. The light energy fills the second elongate section and turns the second elongate section into a xe2x80x9clight pipe.xe2x80x9d The light energy is, in turn, radiated from the second elongate section into the surgical site exposed by the retractor. In this manner, light can be provided from the light source via the optical cable to the illumination input end portion of the second elongate section so that the second elongate section is illuminated, which results in an illuminated surgical field.
A further feature of the preferred form of the present invention is that the second elongate section may be replaceably mounted onto the first elongate section as desired to allow for the use of second elongate sections that direct light energy in a particular manner depending on the intended use of the retractor. A further feature of the preferred form of the present invention is the provision of a shielded portion along the illuminated retractor of the present invention. Additionally, at least a portion of the shaft shaped portion and/or the distal end portion of the second elongate section is preferably spaced apart from at least a portion of the distal end portion of the first elongate section and handle member to ensure that there is no heat buildup between these elements of the illuminated surgical retractor. Alternately, this portion of the second elongate section may be formed with a frosted coating to dissipate light therealong or may be coated to prevent the emission of light therefrom. Additionally, the use of a shield member also protects the distal end portion of the second elongate section and reduces the potential for damage to the surgical drape if the illuminated retractor is inadvertently left on and rested with the face of the retractor against the surgical drape for a short period of time.